The candidate for this K23 Career Development Award aims to become an independent investigator whose work will lead to successful interventions to promote adherence among HIV-infected (HIV+) adolescents, particularly in resource-limited settings. HIV+ adolescents have poor adherence to antiretroviral therapy relative to both adults and younger children. This is of paramount importance in sub-Saharan Africa where about 90% of HIV-infected youth live and where treatment options are limited. For HIV+ adolescents, poor adherence is commonly their greatest barrier to long-term treatment success. In addition, low-cost monitoring strategies such as patient self-report are often less reliable in adolescents. The proposed research will determine whether simply assessed adolescent characteristics can be used to target the choice of low-cost adherence monitoring strategies for individual adolescents. It will also clarify the impact of key potentially modifiabl risk factors on treatment adherence in adolescents, demonstrating targets for future interventional studies to support adherence among adolescents in resource-limited settings. The candidate for this award has a strong background in pediatric and adolescent treatment in resource-limited settings, having worked full-time in Botswana for 4 years as the Associate Director of the Botswana-Baylor Children's Clinical Centre of Excellence (COE). The COE has provided care and treatment to over 2000 HIV+ children and adolescents and is the study site for the K23 research. In addition to her extensive experience in pediatric and adolescent HIV care in resource-limited settings, the candidate for this award has undergone training in clinical epidemiology and is the PI for a CDC Public Health Effectiveness Grant evaluating other aspects of adherence among adolescents in a resource-limited setting. The candidate's primary mentor is Dr. Robert Gross. Dr. Gross is an international expert in HIV adherence research and has an outstanding track record of mentorship. Drs. Steven Feierman, Karen Glanz, Wei-Ting Hwang and Seipone Mphele will serve as co-mentors in the areas of medical anthropology, health behavior, biostatistics, and clinical psychology, respectively. The proposed training and mentorship will provide the candidate with the skills and experience necessary to support her development as a successful independent researcher. The K23 research and training plan will expand her expertise into the areas of behavioral theory, test construction and validation, qualitative and longitudinal analyses, and international research ethics. PUBLIC HEALTH RELEVANCE: The proposed research is likely to improve the accuracy of adherence monitoring for adolescents and to lead to advancements in adolescent adherence support, particularly for resource-limited settings. This will help to improve adolescent HIV treatment outcomes and limit the spread of resistant virus.